{"id":5489,"date":"2011-06-16T01:55:37","date_gmt":"2011-06-16T01:55:37","guid":{"rendered":"http:\/\/crashtext.org\/misc\/regional-anesthesia-of-the-hand-from-mmc.htm\/"},"modified":"2013-02-03T00:07:59","modified_gmt":"2013-02-03T05:07:59","slug":"regional-anesthesia-of-the-hand-from-mmc","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/ultrasound\/regional-anesthesia-of-the-hand-from-mmc.htm\/","title":{"rendered":"Regional Anesthesia of the Hand from MMC"},"content":{"rendered":"

Regional Hand Anesthesia with Ultrasound |<\/span><\/p>\n

Emergency Department Critical CareRegional Anesthesia of the Hand from MMC<\/p>\n

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Department of Emergency Medicine<\/strong> \"\" \"\"<\/p>\n

Regional Anesthesia – Hand<\/strong><\/p>\n

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General<\/strong>:<\/p>\n

These blocks are excellent block for lacerations, puncture wounds or bony dislocations of the hand.\u00a0 They can be used in parts or in combination to provide anesthesia to the entire hand.\u00a0 When performing a complete hand block, the ulna, median and radial nerves should be blocked.<\/p>\n

Ulnar Nerve<\/a>\u00a0\u00a0 \u00a0\u00a0\u00a0\u2022\u00a0\u00a0\u00a0<\/strong>Median Nerve<\/strong><\/a>\u00a0\u00a0\u00a0\u2022\u00a0\u00a0\u00a0<\/strong>Radial Nerve<\/strong><\/a><\/p>\n

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\nUlnar Nerve <\/strong><\/strong><\/p>\n

\"Ulnar<\/a>\u00a0Watch the Video<\/strong> <\/a><\/p>\n

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\nAnatomy:<\/strong><\/p>\n

Identify the flexor carpi ulnaris and ulnar artery by having the have the patient deviate their hand in an ulnar direction at the wrist (giving the thumbs up).\u00a0 The flexor carpi ulnaris is the most medial (ulnar) tendon.\u00a0 The ulnar artery can be palpated just medial and dorsal to the tendon.\u00a0 The nerve lies between the artery and the flexor carpi ulnaris tendon.<\/p>\n

Innervation<\/strong>:<\/p>\n

The ulnar nerve innervates the flexor pollicis brevis, abductor pollicis, palmaris brevis, abductor digiti minimi, flexor digiti minimi opponens digiti minimi, the medial two lumbicals and all the interossei muscles.
\nDistribution of anesthesia:
\nThis procedure provides anesthesia to the entire fifth digit, half of the fourth digit and the medial aspect of the hand and wrist.<\/p>\n

Technique<\/strong>:<\/p>\n

The surgical field should be prepared just proximal (1-2 cm) to the most distal wrist crease.\u00a0 Raise a wheal of anesthetic in the subcutaneous space and insert the needle under the flexor carpi ulnaris one centimeter just palmar to the ulnar styloid.\u00a0 If blood is aspirated, withdraw the needle a few millimeters and aspirate again, the nerve is more superficial from the injection point.\u00a0 Inject approximately 5 to 7 milliliters of anesthetic.\u00a0 To block the cutaneous branches of the ulnar nerve, inject 3 to 5 milliliters of anesthetic just above the tendon of the flexor carpi ulnaris.<\/p>\n

Pitfalls<\/strong>:<\/p>\n